Friday, October 1, 2010

It can be very challenging to determine if a young, non-verbal child has childhood apraxia of speech (CAS) or not. What we can figure out early on in the therapy process is if a young child is having difficulty with motor planning and if so, then we should be using a motor planning approach in therapy. Remember, motor planning difficulties means the child's brain says "act" but the body doesn't respond. So, it is best to start with gross and fine motor imitation skills to figure out if the child can imitate larger muscle movements. The reason we focus so much on motor imitation of actions is because MOTOR IMITATION PRECEDES VERBAL IMITATION! A child must imitate what we do before he will imitate what we say. Below are some suggested motor imitation targets:

clap hands
blow a kiss
bang blocks together
fly a toy plane
knock blocks down
pound with a hammer
roll a ball
stomp feet
wave
knock on door
stick out tongue
push toy car
put on a hat
pat a baby doll
sneeze a block off head

Another way to work on motor imitation skills is through songs and finger plays. Focus on the actions not the words early on. Below are some suggested songs and finger plays:

We must be able to comment on the integrity of the motor planning system when we suspect apraxia in young children. The best way to begin assessing the motor planning system is through gross and fine motor imitation tasks.

Thursday, September 23, 2010

I am busy all the time. I have lots of projects at work, meetings, paperwork, bills to pay, emails to return, powerpoint presentations to finish, insurance companies to fight with... and these tasks keep me busy every second of every day. Sometimes I feel overwhelmed and think there aren't enough hours in the day. And then...something happens that makes me put everything else on the back burner. My father has just been hospitalized after his doctor found a tumor on his spine. So, what seemed to my dad like a pesky back-ache is in reality, cancer. Sometimes this thing called life gets in the way of my projects and activities but I know that family must always come first. So, while I have every intention of posting more about the importance of early intervention in young children who aren't talking, I want to be sure that each of us takes time out of our busy schedule to hug our parents, our spouses, our children and our friends and appreciate the time we have to spend with them. Don't let life get in the way of spending time with those we love.

Sunday, September 19, 2010

I spent last week presenting in North Carolina and Virginia and met a lot of wonderful therapists who spend their days helping young children learn how to talk. Thanks for the great week!

Today I want to talk about what apraxia is and what is isn't. There are many clinical definitions of apraxia available, yet it can be a very abstract concept to understand. First of all, I think it is important to note that there are 3 types of apraxia...limb apraxia, oral apraxia and verbal apraxia. Let's look at these definitions first:

Limb apraxia: Often referred to as dyspraxia. Refers to the inability to make precise movements with the fingers, arms or legs on command.

Oral Apraxia: Refers to the inability to coordinate and carry out oral/facial movements on command (not related to talking).

Verbal Apraxia: Refers to the inability to coordinate and sequence sounds necessary for speech on command.

Both adults and children can have apraxia. Typically we talk about acquired apraxia vs. childhood apraxia. Acquired apraxia is due to brain damage and there is a loss of skill. For example, following a stroke a person may have acquired apraxia. However, when young children never learn to talk due to difficulty with motor planning, we refer to it as Childhood Apraxia of Speech (CAS).

So, what is CAS? There are 2 things it is and 2 things it isn't:

Two things CAS is:
1. CAS is a neurological, brain-based disorder that requires intervention (it is not a developmental delay)
2. CAS interferes with the ability to coordinate and sequence sounds necessary for speech on command

Two things CAS isn't:
1. CAS isn't associated with cognitive deficits (however, children with cognitive deficits can also have CAS)
2. CAS isn't associated with neuromuscular deficits (drooling, for example, is related to muscular weakness or dysarthria, not apraxia)

In a nutshell, a child with Childhood Apraxia of Speech (CAS) has difficulty with motor planning. The child knows what he or she wants to say, but can't get the message from the brain to the mouth. Basically, the brain says "speak" but the mouth doesn't respond.

So, the purpose of early intervention in young children with suspected CAS is to build new neural pathways or fix existing ones and and teach them HOW to talk.

Join me tomorrow as we continue to discuss Childhood Apraxia of Speech.

Tuesday, September 14, 2010

I am off once again to present on Suspected Apraxia and Early Intervention. I will be speaking in Raleigh, NC, Richmond, VA and Norfolk, VA this week. I love to talk to other therapists about helping non-verbal toddlers learn to talk! It is my passion and I can't wait to meet another group of awesome therapists on the east coast. Networking with other professionals is such a rewarding benefit of traveling around the country.

I am such a strong proponent of early intervention because most of brain development occurs prior to age 3. Therefore, the earlier we treat these kiddos, the better their prognosis becomes. We can actually change outcomes in very young, non-verbal children by building new neural pathways in the brain through appropriate intervention. This is why I work exclusively with the birth to 5 population!

When a young child presents with characteristics of a motor planning disorder (Childhood Apraxia of Speech), it is best to begin intervention as soon as possible. Many times I hear people make comments that even though a child is not talking, as long as he understands language, he is probably okay. As professionals I believe we should be HIGHLY concerned about kids with a huge gap between their receptive (understanding) and expressive (talking) language skills. What is causing the child NOT to talk? I frequently hear comments such as "He'll talk when he's ready" or "His sister talks for him" or "He has nothing to say." But what if the child can't talk? What if he knows exactly what he wants to say but he is unable to get the message from the brain to his mouth? What if there is a road-block in the way causing a motor planning disorder? If that is the case, early intervention is necessary!

Join me later for further discussion regarding Childhood Apraxia of Speech! I'm off to North Carolina!

Thursday, September 9, 2010

I work with toddlers every day and I think they are the most fascinating people on the planet. Their eating habits are a bit strange and they can throw some serious tantrums...but they are cute, funny, trusting, lovable and happy! I am always looking to lose a few pounds, but I hate dieting. I came across this Toddler Miracle Diet and I laughed so hard I almost peed my pants. So, read on and ENJOY!! :)

People are always on the lookout for a new diet. The trouble with most diets is that you don't get enough to eat (the starvation diet), you don't get enough variation (the liquid diet), or you go broke (the all-meat diet). Consequently, people tend to cheat on their diets or quit after 3 days. Well, now there's the new Toddler Miracle Diet! Over the years you may have noticed that most 2 year olds are trim. Now the formula to their success is available to all in this new diet. Good Luck!

Day 1:

Breakfast: One scrambled egg, one piece of toast with grape jelly. Eat 2 bites of egg using your fingers; dump the rest on the floor. Take one bite of toast, then smear the jelly all over your face and clothes.

Lunch: Four crayons (any color), a handful of potato chips, and a glass of milk (3 sips only, then spill the rest on the dog).

Dinner: A dry stick, 2 pennies and a nickel, 4 sips of flat Pepsi.

Bedtime Snack: Lick a piece of toast and then throw it on the floor...

Day 2:

Breakfast: Pick up stale toast from kitchen floor and eat it. Drink half bottle of vanilla extract or one vial of food dye.

Lunch: Half a tube of "Pulsating Pink" lipstick and a handful of Purina Dog Chow (any flavor). One ice cube, if desired.

Afternoon Snack: Lick an all-day sucker until sticky, take outside, drop in dirt. Retrieve and continue slurping until it is clean again. Then bring it inside and drop it on the rug.

Dinner: A rock or an uncooked bean, which should be thrust up your left nostril. Pour grape juice all over your mashed potatoes; eat with a spoon.

Day 3:

Breakfast: Two pancakes with plenty of syrup; eat one with fingers, rub in hair. Glass of milk; drink half, stuff other pancake in glass. After breakfast, pick up yesterdays sucker from rug, lick off fuzz, put it on the cushion of your best chair.

Dinner: Dish of ice cream, handful of potato chips, some red juice. Try to laugh some juice through nose, if possible.

Day 4:

Breakfast: A quarter tube of toothpaste (any flavor), bite of soap, an olive. Pour a glass of milk over bowl of cornflakes, add half a cup of sugar...once cereal is soggy, drink milk and feed cereal to the dog.

Wednesday, September 8, 2010

Today, let's talk about two words: therapy and intervention. Typically, these words are used interchangeably. However, in early intervention these two terms should have distinct and different meanings.

Understanding the difference between therapy and intervention is crucial for everyone involved in early intervention, including parents, caregivers and therapists.

Therapy is the time the child spends in direct contact with the therapist each week. Services are provided by the therapist.

Intervention is what occurs the rest of the time between therapy sessions. The family and caregivers provide the intervention.

When a young child receives speech-language therapy through the early intervention program, the goal of therapy should NOT be to teach the child how to talk, follow directions, point to body parts, etc. The goal of therapy should be to provide the family with the competence and the confidence to help their child learn how to talk, follow directions, point to body parts, etc.

The focus of therapy in early intervention should be on caregiver education. While therapists do need to spend some therapy time in direct contact with the child, they also need to spend thoughtful time consulting with and educating families and caregivers about what kind of intervention they can be focusing on until the next therapy session. Therapists should avoid leaving homework per se, but rather provide specific, relevant suggestions that allow the family to incorporate strategies into their existing daily activities and routines (during bath time, during breakfast, when going for a walk, when riding in the car, etc).

In early intervention, we do not use a medical model of service delivery (let me "fix" your child) but rather we use a developmental model that focuses on the entire family, not just the child with special needs.

When a child is learning a new skill, he or she will have to practice that skill often in order for it to become established. One hour per week of therapy is NOT often enough! That is why the intervention piece (provided by the family) is so crucial!

Tid Bit of the Day: Young children who receive early intervention services will make the most progress when the family is actively involved in the intervention process!

Tuesday, September 7, 2010

As I ponder the purpose of my life as a pediatric speech-language pathologist while finishing my pathetic lunch (blueberry yogurt and Batman fruit snacks) I realize that many people, including the families I work with, may not fully understand the difference between speech and language. Do you? I had to go to college to get more knowledge for 6 years to become a speech-language pathologist. It has taken me a long time to really appreciate the differences between speech, language and communication. But I am certain that I take this knowledge for granted and fail to adequately convey this information to the families I see on a weekly basis.

So, my Batman fruit snack inspired Tid Bit of the Day is to help parents understand and appreciate the words communication, speech, language & listening.

Communication - An umbrella term referring to the ability to gain and transfer information through three essential components including speech, language and listening.

Speech - Refers to the spoken words we say; now what we say, but HOW we say it.

Language - Divided into two areas:

Receptive Language - Refers to what we understand or comprehend (input).

Expressive Language - Refers to WHAT we say (output); not how clearly we say it.

Listening - Refers to the brain's input and the way in which we hear and actively process information. Your child may hear you, but he may not always be listening.

So, sometimes in speech-language therapy we are working on improving the child's expressive vocabulary (how many words the child uses) and sometimes we are focusing on improving the child's speech intelligibility (how clearly the words are produced). What is the focus of your child's speech-language therapy sessions right now? If you don't know, be sure to ask!

About Me

I am a Pediatric Speech-Language Pathologist...a mother...an author...a public speaker...a wife...and a cheerleader for families of young children with special needs. I talk a lot, love to talk, and find great joy in teaching young children how to talk!